Spasticity Management

Botox Clinic

Spasticity is a form of increased muscle tone (hypertonia) which is commonly affects those with cerebral palsy. It can cause a range of difficulties for individuals which could include impaired motor function, muscle pain, difficulty walking or contracture of muscles. We are able to provide a range of treatments to help with the management of spasticity in both adults and children. This will be comprised of a personalised programme depending on the needs and goals of the individual.

What services are available for spasticity management?

We offer a number of services in our spasticity management clinic which can be used individually or in conjunction with each other or other suitable services. The services offered are:

Botox Clinic

Serial casting and night splint programmes

Splinting for spasticity

SDR Splints

Physiotherapy

Botox Clinic

Botox (botulinum toxin) is a neurotoxin which reduces spasticity of muscles when injected. It works by blocking the release of signals telling the muscles to contract at the nerve terminals this consequently results in reduced or in some cases eliminated muscle spasms. For more information about our botox clinic please click here.

Serial casting and night splint programmes

Serial casting involves a series of casts worn by an individual which aim to lengthen the muscles, ligaments and tendons. The casts are worn over a period of time and are adjusted each time to ensure progression. Night splints work to have the same aim of serial casting but are only worn at night. These removable splints are used to prevent shortening of the achilles tendon whilst individuals are sleeping. More information about these services can be found here.

Splinting for spasticity

A variety of splints can be used in the management of spasticity including ankle foot orthoses if the feet and legs are affected or hand, wrist or elbow orthoses. Whilst there are a number of suitable stock orthoses and splints available many individuals will receive greater benefit from custom made splints. All splints aim to improve limb posture, improve limb function, prevent or control muscle contractures and also reduce pain and discomfort. If you would like more information about splinting for spasticity please visit our dedicated page here.

SDR Splints

Selective dorsal rhizotomy (SDR) is an operation which is aims to improve spasticity. Following surgery individuals may require splints to aid recovery and support the legs and feet in the correct alignment. More information about SDR splints can be found here.

Physiotherapy

Physiotherapy is essential in the management of spasticity. We recommend that individuals receive physiotherapy in conjunction with all of our spasticity management services. A tailored programme enables the individual to work with our physiotherapist to achieve their own goals at their own pace. This also enables them to get the most out of the other interventions taking place.

What is the process to access spasticity management services?

Spasticity affects every individual differently, for this reason it is important a full assessment takes place to ensure the most appropriate treatment programme is selected. This could be a combination of services or it could be just one service being provided. Our team will discuss with you the different options available and your suitability. You will then be able to make an informed decision about how you would like to proceed. Each service will then have an individual assessment process.

SDR Splints

Botox (botulinum toxin) is successfully used in the treatment of focal spasticity in both upper and lower limbs. Focal spasticity is spasticity which affects a specific muscle or muscle group, botox is not recommended for generalised spasticity. When botox is injected into the affected muscles specific signals sent from the brain via the nerves are blocked. This prevents the muscle from contracting and forces the muscle to relax. Following botox injections it is common for individuals to require casting or splinting to support the muscles in a stretched position combined with physiotherapy.

What are the indications for use of botox?

There are many indications for the use of botox including:

Focal spasticity

Muscle pain

Reduced fine motor function

Reduced function of a limb/limbs

Tremors or spasms

If you are unsure if you would be suitable for botox please contact us to discuss.

What conditions is Botox often used for?

Botox is often used for conditions which affect muscle tone including:

Cerebral palsy

Dystonia

Multiple sclerosis

Torticollis

This list of conditions is not exhaustive. If you are unsure if you would be suitable for botox please contact us to discuss.

What are the benefits of botox treatment?

Botox treatment can provide a range of benefits including:

Reduced spasticity

Improved positioning of limbs

Increased range of movement

Improved stability

Improved walking pattern

Increased fluidity in movements

Reduced pain

Improved fine motor control

Increased walking speed

There are many benefits of botox treatment to find out more please contact us to discuss.

What is the process to be receive botox treatment?

To assess your suitability for botox treatment our team will complete a full examination. If it is felt that you would benefit from botox the team will then establish which muscles are to be targeted through physical examination, ultrasound, nerve stimulation or electromyography. Once identified the muscles will be injected with the required amount of botox depending on a number of factors including the size and number of muscles involved and the level of spasticity. Following your injection/s you will require physiotherapy to ensure the now relaxed muscles work correctly. Orthotics may also be used in conjunction with physiotherapy.

Serial Casting & Night Splint Programmes

Serial casting is an effective treatment which has the aim of stretch the muscles, ligaments and tendons of the leg to reduce tightness/shortening and to enable individuals to walk in a more natural pattern instead of on their toes. Serial casts programmes usually last for between 4 to 8 weeks and involve casts to be changed every 1 to 2 weeks. This allows the angle of the cast to be changed appropriately to ensure progressive stretching is taking place.

Night splints are removeable orthotic splints which hold the leg and foot in a predetermined position consequently stretching the muscles and associated soft tissue whilst the individual sleeps. Night splints are adjustable so as the ankle gains a greater range of motion the angle at which the splint holds the foot will be changed.

What are the indications for use of serial casting or night splints?

There are many indications for using serial casting or night splints. These include:

Reduced range of motion at the ankle

Muscle contracture affecting the foot and ankle

Short or tight leg muscles

If you are unsure if serial casting or night splints would be suitable please contact us to discuss.

What conditions is serial casting or night splints often used for?

Serial casting and night splints are often used for the same conditions including:

Cerebral palsy

Idiopathic toe walking

This list of conditions is not exhaustive. If you are unsure if serial casting or night splints would be suitable please contact us to discuss.

What are the benefits of serial casting and night splints?

There are many benefits that come from using a serial casting and night splint programmes. These include:

Increased range of movement

Reduced spasticity

Improved walking pattern

Reduced pain

Adjustability throughout treatment programme

Increased mobility

There are many benefits following a serial casting or night splint programme, to find out more please contact us to discuss.

What is the process to be undertake a serial casting or night splint programme?

The process to begin a serial casting or night splint programme would be:

Assessment

Measuring / Casting

Fitting

Review

To select the type of programme suitable for your (or your child’s) needs our team will complete a full assessment. This will involve a discussion about your requirements and hopes from treatment as well as a physical examination looking specifically at the range of motion you (or your child) currently has.

If it is felt that night splints will be the most appropriate treatment measurements will be taken and the device will be selected and adjusted for your needs. You will then be required to return for reviews for the device to be adjusted as your range of motion increases.

If serial casting is the selected treatment programme your lower leg and foot will be placed into a cast at a specific angle to create a stretch upon the muscles and soft tissue. Every 1-2 weeks (depending on your treatment programme) you will return to the clinic to have your cast removed and replaced. Each time the cast is applied the angle will be adjusted. Serial cast programmes take place for between 4 and 8 weeks.

Splinting For Spasticity

Spasticity is frequently treated with the use of splints or orthoses. Splints can be used for both upper and lower limb spasticity and can be dynamic or static in the support they provide. Splints are available both as stock items and custom made depending on the requirements.

What are the indications for use of a splint for spasticity?

There are many indications for using splints for spasticity. These include:

Pain

Reduced function of limb/s

Requirement for the prevention or control of a deformity or contracture

Protection (for example if spasticity causes claw hand)

If you are unsure if you would be suitable for a splint for spasticity please contact us to discuss.

What conditions are spasticity splints often used for?

Splints are used in the treatment of spasticity caused by a variety of conditions including:

Cerebral palsy

Stroke

Multiple sclerosis

This list of conditions is not exhaustive. If you are unsure if you would be suitable for a splint for spasticity please contact us to discuss.

What are the benefits of splint for spasticity?

There are many benefits that come from using splints for spasticity. These include:

Decreased spasticity

Improved functionality of limb

Improved walking pattern

Reduced pain

Reduced contracture

There are many benefits using a splint in spasticity management to find out more please contact us to discuss.

What types of splints for spasticity are available?

There are many different splints suitable for treating spasticity including:

Ankle contracture boot

Ankle foot orthoses

Elbow gaiters

Wrist orthoses

Ankle contracture boot

Ankle contracture boots are used when resting or individuals are unable to walk. They work by holding the foot and ankle in a static stretch which can be adjusted depending on the requirements.

Ankle foot orthoses

Ankle foot orthoses (AFOs) are the most commonly used type of splint within the treatment of spasticity. They can be stock or custom made and can include an ankle joint if required. AFOs enable the foot and ankle to be held in a correct position and can help to assist with walking through active assistance.

Elbow gaiters

Elbow gaiters can improve function by maintaining extension of the arm. There is a range of different elbow gaiters available including those with or without a hinge, a hinge can be used if a progressive stretch is required.

Wrist orthoses

Wrist orthoses are available as either static (fixing the wrist in a set angle) or dynamic (allowing specific ranges of motion). A static wrist orthoses holds the hand, wrist and fingers in a neutral position and can help to prevent shortening of tendons. A dynamic wrist orthoses is an adjustable device which can be set to allow specific amounts of flexion and/or extension.

What is the process to be receive a splint for spasticity?

The process to receive a splint for spasticity would be:

Assessment

Measuring / Casting

Fitting

Review

Your assessment for spasticity splints will vary on the type of splint required. However our team will undertake an assessment discussing your requirements and needs as well as observing your level of spasticity and its impact. Using this information the team will make suggestions about appropriate splints. Once the best splint has been selected you will be measured and if required cast. These details will then be sent to your manufacturer for your splint to be made. On completion you will be required to attend for a fitting where you will be shown how to wear and use your splint.